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Obesity and cardiac function.

We studied 10 obese volunteers, mean age 36.5 +/- 10.3 years, who weighed 123.56 +/- 28.7 g and were 69.96 +/- 22.5 kg overweight. The subjects did not have diabetes, arterial hypertension or signs of cardiac and respiratory failure or disease and all underwent right- and left-heart catheterization. cardiac output and stroke volume were high, according to increased oxygen consumption and to the degree of obesity. Ventricular end-diastolic and atrial pressures ranged from normal to high and correlated with body weight, signs of volume overloading and reduced left ventricular (LV) compliance. The mean pulmonary artery pressure was elevated and correlated well with weight, pulmonary resistance being normal; mean aortic pressure did not correlate with weight, and systemic arterial resistance tended to have a negative correlation. The LV function curve showed impaired ventricular function, particularly for the heaviest subjects, in whom Vmax and the ratio of the stroke work index to LV end-diastolic pressure were reduced. These indexes correlated well with each other and both correlated negatively with the degree of obesity. In contrast, maximal dP/dt was normal and did not correlate with excess weight. These observations show that depressed LV function is already present in relatively young obese people, even if they are free from signs of cardiopathy and other associate diseases. The degree of impairment of heart function seems to parallel the degree of obesity.

Adult↗

Lack of osteopontin improves cardiac function in streptozotocin-induced diabetic mice.

The purpose of this study was to investigate the role of osteopontin (OPN) in diabetic hearts. Diabetes was induced in wild-type (WT) and OPN knockout (KO) mice by using streptozotocin (150 mg/kg) injection. Left ventricular (LV) structural and functional remodeling was studied 30 and 60 days after induction of diabetes. Induction of diabetes increased OPN expression in cardiac myocytes. Heart weight-to-body weight ratio was increased in both diabetic (D) groups. Lung wet weight-to-dry weight ratio was increased only in the WT-D group. Peak left ventricular (LV) developed pressures measured using Langendorff perfusion analyses were reduced to a greater extent in WT-D versus KO-D group. LV end-diastolic pressure-volume curve exhibited a significant leftward shift in WT-D but not in KO-D group. LV end-diastolic diameter, percent fractional shortening, and the ratio of peak velocity of early and late filling (E/A wave) were significantly reduced in WT-D mice as analyzed by echocardiography. The increase in cardiac myocyte apoptosis and fibrosis was significantly higher in the WT-D group. Expression of atrial natriuretic peptide and transforming growth factor-beta1 was significantly increased in the WT-D group. Induction of diabetes increased protein kinase C (PKC) phosphorylation in both groups. However, phosphorylation of PKC-betaII was significantly higher in the WT-D group, whereas phosphorylation of PKC-zeta was significantly higher in the KO-D group. Levels of peroxisome proliferator-activated receptor-gamma were significantly decreased in the WT-D group but not in the KO-D group. Thus increased expression of OPN may play a deleterious role during streptozotocin-induced diabetic cardiomyopathy with effects on cardiac fibrosis, hypertrophy, and myocyte apoptosis.

Animals↗

[Evaluation of cardiac function in dentists during professional activity].

In this study research was carried out a comparison between different dental situations by using a common parameter: myocardial oxygen consumption, accurately expressed in terms of cardiac exercise. Important increase in the previously specified parameter in dentists were provocated by dental extractions conducted on anxious patients. Tooth extractions undertaken on calm and cooperative patients determined an increase of cardiac exercise in dentists similar to those caused by amalgam restoration conducted on a manikin, but not in ergonomic work conditions. The situation, referred previously, resulted more stressing for the dentist, as regard to a similar restoration conducted, this time, in ergonomic work conditions. Amalgam restoration performed on calm and cooperative patients caused alterations of cardiac exercise as referred previously to those provocated by a similar restoration conducted on a manikin in ergonomic conditions. These findings show that work conditions and patients anxiety have a negative influence on the dentists' cardiovascular apparatus. The corrisponding poor modification of the oxygen consumption in the whole organism demonstrates that major part of cardiac exercise is dissipated by stress.

Anxiety↗

Cardiac function of patients with essential hypertension during exercise and isoproterenol infusion.

The left ventricular function of patients with essential hypertension was examined during exercise and isoproterenol (ISP) infusion echocardiography. Twenty-eight hypertensive patients without cardiac hypertrophy (Group NH), 20 patients with cardiac hypertrophy (Group HH), 7 patients with cardiac dilatation (Group D), and 13 normotensives (Group N), were studied during multistage exercise using a supine bicycle ergometer. In addition, 23 hypertensives (Group NH: 13 patients, Group HH: 10 patients) and 10 normotensives were studied during ISP infusion (0.005 microgram/kg/min, and 0.01 microgram/kg/min, respectively, for 5 min). To assess the left ventricular function, an M-mode echocardiogram was utilized at rest and during exercise and ISP infusion. At rest, the isovolumic relaxation time (IRT) of each hypertensive group was significantly longer than that of Group N. IRT of Group HH and Group D was significantly longer than that of Group NH. Only the shortening fraction (SF) of Group D was significantly smaller than that of Group N. During exercise the SF increased in all groups, and only the SF of Group D was significantly smaller than that of Group N at a load of 75 W as well as at rest. The SF of Group HH tended to be smaller. There was no significant difference in peak negative dD/dt (-dD/dt) between any of the groups at rest; however, the -dD/dt of Group HH was significantly smaller than that of Group N during ISP infusion. We concluded that left ventricular diastolic function was disturbed in each hypertensive group at rest. Diastolic dysfunction worsened in Group HH and Group D. Only the left ventricular systolic function of Group D was already depressed at rest. Furthermore, unmanifested systolic dysfunction of the left ventricle seemed to be present in Group HH, because SF during exercise tended to be smaller and -dD/dt during ISP infusion was significantly smaller than that of Group N.

Adult↗

[Atenolol, its cardioselective property for adrenergic beta-receptor blocking action and effect on the cardiac function (author's transl)].

Cardioselective property of the beta-adrenoceptor blocking action of atenolol and its effect on the AV conduction, the atrial muscle refractory period and the cardiac contractility were studied in comparison with these of propranolol. A ratio of pA2 values obtained in the isolated right-atrial preparations and the isolated tracheal preparations of guinea pigs demonstrated that atenolol was highly cardioselective, while propranolol was non-selective. This cardioselective property of atenolol was confirmed in in vivo experiments using guinea pigs. Atenolol increased the AV conduction time and decreased the cardiac contractility dose-dependently in anesthetized dogs of which the heart was electrically driven at fixed rates. At 140 beats/min, AV block was observed at 10 mg/kg, i.v. in 3 of 8 dogs, and further increase in a dose ti 30 mg/kg resulted in acute heart failure in one of remaining 5 dogs, while propranolol, though showing a tendency to be less potent in depressing AV conduction in a dose range less than 0.3 mg/kg, produced a state of heart failure in 2 of 5 dogs at 3 mg/kg, i.v. and AV block in all of the remainder at 10 mg/kg, i.v. Functional refractory period of AV node as well as functional and effective refractory period the the atrial muscle were increased dose-dependently by atenolol and propranolol. There were no significant differences between both drugs regarding these effects. Further increase in a pacing rate to 160 and 180 beats/min augmented the depressing effect of both drugs on the AV conduction.

Adrenergic beta-Antagonists↗

Is the failing heart energy starved? On using chemical energy to support cardiac function.

The requirement of chemical energy in the form of ATP to support systolic and diastolic work of the heart is absolute. Because of its central role in cardiac metabolism and performance, the subject of this review on energetics in the failing heart is ATP. We briefly review the basics of myocardial ATP metabolism and describe how this changes in the failing heart. We present an analysis of what is now known about the causes and consequences of these energetic changes and conclude by commenting on unsolved problems and opportunities for future basic and clinical research.

Adenosine Triphosphate↗

Sequence of occurrence of abnormal regional cardiac function, global pump function and electrocardiogram after brief ligation and reperfusion of a coronary artery.

The following results were obtained. During brief ligation of the coronary artery, a change in the cardiac wall motion appeared as the first abnormality of the CMG. Succeedingly, epicardial ECG changes were recognized, and lastly, changes of dP/dt appeared. After reperfusion of the coronary artery, dP/dt was quickly normalized, followed by restoration of ST elevation. Cardiac motion, measured by CMG, was the last abnormality to improve.

Animals↗

Noninvasive evaluation of cardiac function in hypothyroidism. Response to gradual thyroxine replacement.

Left ventricular performance was studied in 15 patients with severe, primary hypothyroidism (mean serum total thyroxine of 0.8 mug per 100 ml and serum thyrotropin of 160 muU per milliliter). Pretreatment systolic-time intervals were characterized by prolongation of the pre-ejection period (delta PEP = +30) and reduction of the left ventricular ejection period (delta LVET = -23) with a resultant increase in the PEP/LVET ratio (0.47). Nine of 14 patients demonstrated pericardial effusions. These abnormalities were reversed with physiologic thyroxine replacement. Further reductions of the delta PEP and PEP/LVET ratio occurred with supraphysiologic doses (200 to 300 mug per day). During therapy, delta PEP was inversely correlated with serum thyroxine (P less than 0.001) and directly correlated with serum thyrotropin (P less than 0.001). Thus physiologic thyroid hormone replacement, appropriately adjusted to need, appears necessary in hypothyroidism for optimal left ventricular function.

Adult↗